This 4 year longitudinal, urban, multi-method ethnographic study will examine cross cultural healthcare encounters. The study will identify, describe and situate how families contribute to the production of culturally responsive care and the strategies families and practitioners employ to establish commonality, bridge difference, and effectively "partner up." This is a continuation of Boundary Crossing: A Longitudinal and Ethnographic Study (R01 HD 38878, 2000-2004). It builds upon research conducted with a cohort of African American children with special health care needs, their primary caregivers, extended family networks, and the practitioners who serve them. Although there is an overwhelming body of literature confirming health care disparities for ethnic minorities, there is a striking paucity of strategies to address this significant public health issue. Much research on cultural competence radically underestimates how much work families do to achieve culturally competent care. Longitudinal and learning aspects are under-described, as are their strengths and resources families bring to healthcare encounters. The proposed research is both events centered and longitudinal. We will examine how discrete moments of healthcare encounters produce effects across both contexts and time, influencing developmental trajectories, family life, and health and therapeutic outcomes. The anticipated outcomes of this project are a description and interpretation of: 1) the knowledge and strategies families bring to shape encounters and generate desirable outcomes; 2) how families and practitioners revise their strategies; 3) how practitioners, family, and children develop and draw upon their history of shared endeavors; 4) how practitioners shape intervention to the unique needs and strengths of family and child; 5) how families and practitioners challenge and attempt to disconfirm stereotypes; and 6) the cultural resources practitioners and families draw upon. Findings that will result from this study will facilitate a reconsideration of dominant models of cultural competence and health literacy at multiple policy levels.